Healthcare Provider Details

I. General information

NPI: 1861989022
Provider Name (Legal Business Name): IDEAL OPTION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 NE BURNSIDE RD
GRESHAM OR
97030-5711
US

IV. Provider business mailing address

5615 DUNBARTON AVE
PASCO WA
99301-8216
US

V. Phone/Fax

Practice location:
  • Phone: 877-522-1275
  • Fax: 509-491-3031
Mailing address:
  • Phone: 877-522-1275
  • Fax: 509-491-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRIAN JEFFERSON DAWSON
Title or Position: CMO
Credential: MD
Phone: 509-222-1275